Use of the minicondylar plate in metacarpal and phalangeal fractures

The minicondylar plate is used for unstable intraarticular and periarticular fractures of the phalanges and metacarpals to provide stability and to allow early motion. This low profile implant can be placed laterally to avoid injury to the extensor mechanism. The authors retrospectively reviewed 53 consecutive patients from 2 institutions in whom 68 fractures (41 metacarpal and 27 phalangeal) had been treated with 1.5-mm or 2-mm minicondylar plates. Common mechanisms of injury were gunshot wounds, crush injuries, and assault/beatings. Thirty-seven fractures were open, 19 had severe soft tissue injury, and 30 required a bone graft. The followup period averaged 17 months. There were no nonunions or malunions. Sixty-seven complications were associated with 40 fractures in 29 patients: primarily symptomatic plates or pullout (30 complications), extensor lag (13 complications), and infections (8 complications). The complication rate was significantly higher in intraarticular and periarticular fractures also involving the middle 1/3 versus proximal 1/3 fractures; open versus closed fractures; fractures with increased soft tissue injury versus minimal injury; and bone grafted versus nongrafted fractures. Final arc of total active motion, available for 45 fractures, was excellent (> or = 221 degrees) for 17 fractures; good/fair (121 degrees to 220 degrees) for 15, and poor (< or = 120 degrees) for 13. Metacarpal fractures had a significantly higher percentage of excellent results than did phalangeal fractures. Final motion did not correlate significantly with complication rate, severity of soft tissue injury, location in the bone, open versus closed fracture, or use of bone graft. When fractures cannot be restored and stabilized reliably by less invasive methods, the minicondylar plate provides secure fixation and can result in adequate function, even in the presence of severe combined injuries.